Appendicitis Causes and Treatment

Appendicitis is inflammation of the appendix. The appendix is a small, tube-like organ in the lower right portion of your abdomen that is attached to the large intestine (colon). Appendicitis occurs when the appendix becomes blocked, causing swelling, obstruction of blood flow, and tissue death. Severe cases can lead to a ruptured appendix.

Symptoms include pain near the belly button that gradually moves to the right side, accompanied by nausea, vomiting, fever, and chills. Appendicitis is usually treated with surgery but may occasionally resolve with antibiotics alone.

This article describes the symptoms, causes, diagnosis, and treatment of appendicitis. It also explains what "silent appendicitis" is and who is most commonly affected.

How to Tell If You Have Appendicitis

Appendicitis is easily mistaken for other common causes of abdominal pain, including severe constipation or menstrual cramps. Even so, appendicitis tends to develop in a specific pattern that differentiates it from other causes.

With appendicitis:

• The pain is migratory, starting around the naval (belly button) and moving to the lower right abdomen as the pain intensifies.
• The pain worsens when moving, taking deep breaths, coughing, or sneezing.
• The pain is accompanied by tenesmus (the feeling you need to poop even when the bowel is empty)

Other accompanying symptoms of appendicitis include:

• Fever
• Loss of appetite
• Abdominal swelling
• Indigestion
• Nausea and vomiting
• Constipation or diarrhea
• Inability to pass gas
  

Silent Appendicitis

Some people have "silent appendicitis," meaning appendicitis with no overt or readily recognizable symptoms. This is a serious condition as it increases the risk of an appendix rupture. The most common symptom is abdominal swelling and a general feeling of unwellness.

People at risk of silent appendicitis include:

• People on immunosuppressant drugs
• Organ transplanted recipients
• People with uncontrolled diabetes
• People on chemotherapy
• People with obesity
  

People who are pregnant also may not experience the classic signs of appendicitis, especially in the third trimester. Symptoms in children may also be less obvious, especially in small children who are unable to communicate what they are feeling.

Older adults with appendicitis often only have a slight fever and mild abdominal pain and may not recognize the condition until the appendix is close to rupturing.

For these reasons, any abdominal pain that persists and gets worse should be seen by a healthcare professional if only as a precaution.

What Triggers Appendicitis?

While anyone can get appendicitis, it occurs most often between the ages of 10 and 30. In the United States, over 200,000 hospitalizations involve appendicitis each year. Appendicitis is also the leading cause of emergency room visits requiring hospitalization for kids ages 5 to 17 years.

Appendicitis occurs when the appendix is blocked by stool or other causes. The process of the disease involves characteristic steps:

1. Once a blockage occurs, mucus normally produced by the appendix starts to back up, causing the organ to swell.
2. The increased pressure causes blood vessels in the wall of the appendix to become pinched and collapse.
3. The blockage of these vessels not only reduces blood flow to the appendix but also causes blood clots to form, further obstructing circulation.
4. The loss of blood supply causes tissue death (necrosis) and gangrene.
5. Tissue death, in turn, causes pockets of pus (abscesses) to form in the walls of the appendix.
6. If left untreated, the continued swelling can cause the organ to spontaneously burst (rupture).
7. The rupture can spread infection to the abdomen, leading to a potentially life-threatening condition known as sepsis.

In addition to stool, the blockage of the appendix may be caused by abdominal trauma or acute lymphadenitis (swelling of lymph nodes caused by a bacterial or viral infection).

How Appendicitis Is Diagnosed

The diagnosis of appendicitis involves a review of your medical history, a physical exam, and various lab and imaging tests.

Physical Examination

During the physical exam, palpation (light touch) and manipulation are used to detect and characterize the nature of your nature.

Physical signs of appendicitis include:

• Guarding: The reflexive tensing of muscles in response to touch
• Rebound tenderness: Tenderness felt more when pressure is released than when it is applied
• Rovsing's sign: Pain on the right side of the abdomen when pressing on the left
• Psoas sign: Pain that occurs with hip flexion (bending of the hip)
• Obturator sign: Pain that occurs when the hip is rotated internally
  

Lab Tests

While there is no lab test specific to appendicitis, a complete blood count (CBC) is typically done to check for signs of infection or inflammation. In children, a component of the CBC known as neutrophil-lymphocyte ratio (NLR) offers a high degree of accuracy in diagnosing acute appendicitis.

Other blood tests that detect generalized inflammation include C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR).

Imaging Tests

Medical imaging is central to the diagnosis of appendicitis and can help characterize the severity of the condition and the likelihood of a rupture.

By far the most common test used is a specialized form of X-ray called a computed tomography (CT) scan which can provide cross-sectional views of the appendix.

Sometimes, magnetic resonance imaging (MRI) may be used in people who are pregnant as it generates images with magnetic and radio waves rather than radiation.

How Is Appendicitis Treated?

Acute (sudden, severe) appendicitis is treated with surgery called an appendectomy to remove the appendix. The operation can be performed as a traditional open surgery (with a scalpel and a large incision) or with laparoscopic surgery (with small "keyhole" incisions and specialized, narrow surgical instruments).

As the appendix serves no function in the human body, it is almost always removed even if it is relatively normal. This avoids repeat episodes in the future.

Recovery from an appendectomy takes several weeks. Pain medications and antibiotics may be prescribed, and you will be advised to limit physical activity for 3 to 5 days if you had a laparoscopic appendectomy and up to 14 days if you had an open appendectomy.

Summary

Appendicitis is inflammation of the appendix caused by blockage of the organ by stool or other causes. If left untreated, the appendix can swell and possibly rupture. A classic sign of appendicitis is pain that starts at the navel and gradually moves to the lower left abdomen as it worsens.

Appendicitis can be diagnosed with a physical exam and imaging tests. The treatment almost always involves an appendectomy to remove the appendix. Certain cases may resolve without surgery using intravenous antibiotics.